SIGNIFICANT REDUCTION IN CARBAPENEM AND FLUOROQUINOLONE USE WITH IMPLEMENTATION OF MULTIFACETED ANTIBIOTIC STEWARDSHIP PROGRAM (ASP) INTERVENTIONS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: To study the impact of antimicrobial stewardship program (ASP) interventions on carbapenem and fluoroquinolone (FQ) use at our tertiary care center. METHODS: A multifaceted was implemented in July 2018 a 160-bed center serving tristate area Iowa, South Dakota Nebraska. Carbapenem FQ during pre-ASP intervention period (P1: 12/01/2016-6/30/2018) compared with ASP-intervention (P2: 07/01/2018-1/31/2020). ASP included: educational pearls monthly physician newsletters; posters high-traffic provider areas; suppression results microbiology susceptibility reports; distributing data to providers; counseling for appropriate ordering; creating alternative alert order-entry software; generating pharmacy decision-support software algorithms aid identifying opportunities; removing from HAP/VAP ordersets carbapenems order-sets where appropriate; default antibiotic stop dates changed 7 days EMR (Epic); adverse effects warning fired as an when ordering FQ. Additional pharmacist included procalcitonin protocol allowing pharmacists reorder follow-up make recommendations discontinue therapy appropriate. RESULTS: declined significantly mean 64.81 (DOT) per 1000 patient P1 8.91 DOT P2 (p< 0.001). 133 46 0.0001) P2. All hospital units showed significant decrease use, intensive step-down unit noting 85.7% reduction 0.00001) (ICUs, medical surgical) 52% P1. During P2, 55% orders were found be only 39% 0.0001). Sensitivity profile Pseudomonas aeruginosa improved 86% sensitivity 89% No Carbapenem-Resistant Enterobacteriaceae isolates identified period. remained stable 81%. Cost savings $757 recognized result reduced use. CONCLUSIONS: decline total utilization ICUs showing >50% decline, increase proportion well cost observed interventions. CLINICAL IMPLICATIONS: According CDC, fluoroquinolones should key targets programs reducing inappropriate is imperative preventing emergence multidrug resistance potentially improving bacterial patterns. With interventions, we demonstrated these two classes broad-spectrum antibiotics, notably ICUs. We also noted use; considerable savings. DISCLOSURES: relevant relationships by Sandeep Gupta, source=Web Response Ashlesha Kaushik, Michael Padomek, Corey Thieman,